Baseball’s Elbow Problem Starts with Young Pitchers

The Atlantic—July 23, 2014

Part of the tradition of baseball has always been its love affair with statistics, especially the ones that seek to predict what will happen on the field—the chance of getting a hit, the odds of making an error. But there's one record-setting statistic that baseball isn't celebrating—the increasing occurrence of arm surgeries among its young pitchers. With already 46 "Tommy John" elbow surgeries in Major League Baseball at the midpoint of the season, this year is on pace to exceed the number of elbow surgeries in 2012, the year with the current record. But no statistic has been able to determine why pitchers are getting injured at higher and higher rates. Frustratingly, for the teams with these high-value young throwers, scrutinizing numbers like pitch counts and innings pitched in an attempt to predict or limit risk seemingly hasn't stemmed the rising tide of hurt players.

In the baseball world, no injury has captured more attention than the "Tommy John" surgery. Named for Los Angeles Dodgers pitcher Tommy John, the first player who underwent successful surgery for repair of a torn ulnar collateral ligament (UCL), the surgery restores the stability of the elbow.

So physicians and sports medicine researchers are tasked with battling the perception of youth or high school athletes whose vision of the surgery is dominated by the ESPN highlights of Tommy John success stories. Those experts fear that portrayal of the procedure might push athletes toward surgeries that they don't need. Dr. Joshua Dines, an orthopedic surgeon who regularly performs Tommy John surgeries and has studied their effects in Major League Baseball, states, "There is a clear belief in the baseball community that Tommy John surgery will enhance performance." Instead of rushing to surgery, Dines and others believe that young throwers should be educated on how to avoid arm problems, not just pitch through pain until surgery is the only option.